Recent advances in the treatment of hepatitis C virus (HCV)
infection have led to the availability of both highly efficacious
interferon-containing and
interferon-sparing regimens. However, the use of such
therapies faces restrictions due to high costs. For patients who are medically eligible to receive
interferon, the choice between the two will likely be impacted by preferences surrounding
interferon, severity of disease, coverage policies and out-of-pocket costs. We developed a decision model to quantify the trade-offs between immediate,
interferon-containing
therapy and delayed,
interferon-free
therapy for patients with chronic, genotype 1 HCV
infection. We projected the quality-adjusted life expectancy stratified by the presence or absence of
cirrhosis for four strategies: (i) no treatment; (ii) immediate, one-time treatment with an
interferon-containing regimen; (iii) immediate treatment as above with the opportunity for
retreatment in patients who fail to achieve sustained virologic response with
interferon-free
therapy in 1 year; and (iv) delayed
therapy with
interferon-free
therapy in 1 year. When compared to one-time immediate treatment with the
interferon-containing regimen,
delayed treatment with the
interferon-free regimen in 1 year resulted in longer life expectancy, with a 0.2 quality-adjusted life year (QALY) increase in noncirrhotic patients, and a 1.1 QALY increase in patients with
cirrhosis. This superiority in health benefits was lost when wait time for
interferon-free
therapy was greater than 3-3.2 years. In this modelling analysis,
interferon-free
therapy resulted in superior health benefits compared to immediate
therapy with
interferon until wait time exceeded 3-3.2 years. Such data can inform decision-making regarding treatment initiation for HCV as healthcare financing evolves.